Jackie Anne Bruss

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

623212 Issued in MN

Practice address

125 2ND Ave NW
Plainview, MN 55964-1222

Phone

(507) 951-3830

NPI assigned

Jul 5, 2024

Last updated

Jul 5, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1720137600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720137600000",
    "number": "1114763430",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "64751 141ST AVE",
            "city": "WABASHA",
            "state": "MN",
            "postal_code": "559817592",
            "telephone_number": "507-450-7437"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 2ND AVE NW",
            "city": "PLAINVIEW",
            "state": "MN",
            "postal_code": "559641222",
            "telephone_number": "507-951-3830"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRUSS",
        "first_name": "JACKIE",
        "middle_name": "ANNE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-07-05",
        "last_updated": "2024-07-05",
        "certification_date": "2024-07-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "MN",
            "license": "623212",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• City of Plainview (Plainview Ambulance)
• Nicholle Diane Corcoran, DC
• Dr J L Stucky Chiropractor PA
• Jessica Elizabeth Fairclough

• Licensed Practical Nurse in Plainview, MN
• Providers in Plainview, MN by specialty
• Licensed Practical Nurse in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.